Individual provider · NPI-1

Mohamed Abo-Basha

Dentist · Oklahoma City, OK

NPI number1093643629
StatusActive
Last updated in NPPESJun 15, 2026

Details

NPI
1093643629
Entity type
Individual (NPI-1)
Name
Mohamed Abo-Basha
Sex
Male
Sole proprietor
No
Enumeration date
May 12, 2026
Certification date
Jun 15, 2026
Last updated
Jun 15, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist8182OKYes

Practice location

6217 S Western Ave
Oklahoma City, OK 73139-1605

Phone 405-896-9052

Mailing address

2828 Nw 30th St
Oklahoma City, OK 73112-7404

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